Isolation, Behavioral Changes, and Low Seroprevalence of SARS–CoV‐2 Antibodies in Patients With Systemic Lupus Erythematosus or Rheumatoid Arthritis

Abstract

Objectives Patients with chronic rheumatic diseases (CRD), such as Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA), require special attention during the COVID‐19 pandemic, as they are considered at risk of severe infections. We assessed the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antibodies in patients with SLE and RA and patient behavior, disease‐related symptoms, and mental health. Methods More than 900 participants were included: 405 patients with RA or SLE (CRD‐patients) and 513 blood donors. All participants had blood SARS‐CoV‐2 total antibodies measured (sensitivity 96.7%, specificity 99.5%) and answered a questionnaire concerning behavior, anxiety, and symptoms of depression (PHQ‐9). The CRD patients were further asked about physical activity, adherence to medication, and disease‐related symptoms. Results CRD‐patients had a significant lower seroprevalence of SARS‐CoV‐2 antibodies (n=1/365, 0.3%) compared to blood donors (n=10/513, 1.9%) (p=0.03). Almost 60% of patients were unable to exercise as usual, increased pain was experienced by 34% of patients and increased disease activity by 24%. Almost 10% of patients reduced or discontinued their immunosuppressive treatments at their own initiative. Symptoms of moderate depression were present in 19% of patients compared to 6,8% blood donors (p<0.001). Conclusions Low seroprevalence in patients with CRDs indicates successful mitigation of exposure to SARS‐CoV‐2. However, this appears to occur at the expense of physical activity, experience of increased pain, disease activity, and symptoms of depression. There is a need for care providers to be aware of these negative side‐effects and for further studies to investigate the possible long‐term consequences.

SARS-CoV-2 seroprevalence, seroconversion and neutralizing antibodies in a systemic lupus erythematosus cohort and comparison to controls

“…This and the absence of SARS-CoV2 antibodies in pre-pandemic sera suggests that molecular mimicry is an unlikely explanation for SARS-CoV-2 seropositivity. 6 Like other reports, 3,7,8 our SLE cohort had a lower rate of seropositivity pre-pandemic and a slightly lower to similar rate of seropositivity intra-pandemic compared to contemporaneous controls. In contrast, over a similar observation period, others reported that 4% (4/100) SLE patients had PCR-confirmed infection, but 36% showed SARS-CoV-2 antibodies of at least one isotype, particularly IgA and IgM.…”

Estimation of SARS-CoV-2 Infection Fatality Rate by Age and Comorbidity Status Using Antibody Screening of Blood Donors During the COVID-19 Epidemic in Denmark

“…Thus, a recent study showed seroprevalence of SARS-CoV-2 antibodies among blood donors to be several-fold higher (1.9%) than among patients with chronic rheumatic diseases (0.3%). Thus, we speculate that the risk of infection was lower among people with preexisting disease [ 36 ]. Plausible mechanisms to explain this include increased compliance regarding social distancing and self-isolating after exposure to close encounters of COVID-19 cases.…”

Local and systemic reactogenicity of COVID-19 vaccine BNT162b2 in patients with systemic lupus erythematosus and rheumatoid arthritis

“…Patients were recruited from the COPANARD (Corona Pandemic Autoimmune Rheumatic Disease) cohort [3]. Outpatients with SLE or RA were identified through hospital records at the Department of Rheumatology, Aarhus University Hospital, Denmark.…”

“…American College of Rheumatology (ACR) has recommended vaccination of patients with rheumatic diseases and considers this group to be at higher risk of severe COVID-19 than the general population [1,2]. A further encouragement of vaccination has been that the COVID-19 pandemic has prompted isolation in patients with rheumatic diseases [3,4].…”